Background: The Learning Environment (LE) influences the performance of students, learning, social life, mental health, and the future of work. Aim: To assess the learning environment (LE) among medical residents of 64 specialties. Material and Methods: Two validated instruments “Postgraduate Hospital Education Environment Measure” (PHEEM) and “Ambulatory Care Learning Educational Environment” (ACLEEM), and open questions were answered online by 1259 residents from 15 universities. A descriptive and analytical statistical analysis and semantic deductive-inductive analyses of open questions were performed. Results: LE was positive rather than negative (PHEEM of 100.5 points (79-116) and ACLEEM of 138.5 points (120-157)). An age over 32 years, male sex, studying in a private university, being in first year of residence and being in a non-surgical specialty were associated with a better PHEEM score (p < 0.05). For ACLEEM, the first year of specialty, a non-surgical specialty and studying in a private university were associated with better scores (p < 0.05). Two programs had excellent LE (Pathological Anatomy and Ophthalmology) and no specialty had a very poor performance or many problems. Aspects of teaching, clinical activities, and teachers were strengths reported by students. Aspects to improve were teaching, protected times and clinical activities. Conclusions: LE among medical specialties had more positive than negative features, but with areas that should be improved.

ABSTRACT BACKGROUND: Hydatid disease, a parasitic infestation caused by Echinococcus granulosus larvae, is an infectious disease endemic in different areas, such as India, Australia, and South America. The liver is well known as the organ most commonly affected by hydatid disease and may present a wide variety of complications such as hepatothoracic hydatid transit, cyst superinfection, intra-abdominal dissemination, and communication of the biliary cyst with extravasation of parasitic material into the bile duct, also called cholangiohydatidosis. Humans are considered an intermediate host, exposed to these larvae by hand-to-mouth contamination of the feces of infected dogs. AIM: This study aimed to highlight the role of endoscopic retrograde cholangiopancreatography in patients with acute cholangitis secondary to cholangiohydatidosis. METHODS: Considering the imaging findings in a 36-year-old female patient with computed tomography and magnetic resonance imaging showing a complex cystic lesion in liver segment VI, with multiple internal vesicles and a wall defect cyst that communicates with the intrahepatic biliary tree, endoscopic biliary drainage was performed by endoscopic retrograde cholangiopancreatography with papillotomy, leading to the discharge of multiple obstructive cysts and hydatid sand from the main bile duct. RESULTS: Clinical and laboratory findings improved after drainage, with hospital discharge under oral antiparasitic treatment before complete surgical resection of the hepatic hydatid cyst. CONCLUSIONS: Endoscopic retrograde cholangiopancreatography is a safe and useful method for the treatment of biliary complications of hepatic hydatid disease and should be considered the first-line procedure for biliary drainage in cases of cholangiohydatid disease involving secondary acute cholangitis.

RESUMO RACIONAL: A doença hidática, uma infestação parasitária causada pelas larvas de Echinococcus granulosus, é uma doença infecciosa endêmica em diferentes áreas como Índia, Austrália e América do Sul. O fígado é conhecido como o órgão mais comumente afetado pela hidatidose, podendo apresentar uma grande variedade de complicações como trânsito hidático hepato-torácico, superinfecção do cisto, disseminação intra-abdominal e comunicação do cisto biliar com extravasamento de material parasitário para o ducto biliar ou também chamada de colangio-hidatidose O ser humano é considerado um hospedeiro intermediário, exposto a essas larvas pela contaminação mão-boca das fezes de cães infectados. OBJETIVO: Destacar o papel da endoscópica por colangiopancreatografia retrógrada em pacientes com colangite aguda secundária à colangio-hidatidose. MÉTODOS: Considerando os achados de imagem, em paciente feminina de 36 anos de idade, com imagens de tomografia computadorizada e ressonância magnética mostrando uma lesão cística complexa no segmento hepático VI, com múltiplas vesículas internas e um defeito de parede cística que se comunica com a árvore biliar intra-hepática foi realizada drenagem biliar endoscópica por colangiopancreatografia retrógrada com papilotomia, levando à descarga de múltiplos cistos obstrutivos e areia hidática da via biliar principal. RESULTADOS: Os achados clínicos e laboratoriais melhoraram após a drenagem, com alta hospitalar sob tratamento antiparasitário oral antes da ressecção cirúrgica completa do cisto hidático hepático. CONCLUSÕES: A endoscópica por colangiopancreatografia retrógrada é um método seguro e útil para o tratamento das complicações biliares da hidatidose hepática, devendo ser considerado o procedimento de primeira linha para drenagem biliar nos casos de colangio-hidatidose que envolve colangite aguda secundária.

En los laboratorios de la Universidad de Santiago de Chile se obtuvo un acero Dual Phase mediante un proceso de laminación en caliente y bobinado, a partir de un acero al C-Mn-Si AWS 70S-6 producido por la Compañía Siderúrgica Huachipato (CSH), el cual se usa para fabricar electrodos para la industria de la soldadura. Su microestructura consiste en martensita en una matriz ferrítica. Esta información fue complementada con ensayos de tracción y anisotropía. Se determinó que las condiciones óptimas para la obtención de la microestructura Dual Phase, a partir del acero inicial, están dadas por una temperatura de término de laminación seguida por un temple hasta el rango óptimo de temperaturas de bobinado (550 - 600 ºC) y posterior enfriamiento en el horno. Adicionalmente, se tomaron tres muestras del acero para someterlas a distintos tratamientos térmicos con el objetivo de obtener una estructura dual phase en la primera probeta; ferrita, bainita y perlita en la segunda, y perlita en una matriz ferrítica en la tercera. Posteriormente se procedió a soldar las probetas con un proceso de soldadura MIG. En todos los casos, las propiedades mecánicas de la zona afectada térmicamente no se diferenciaron grandemente de sus respectivos metales base. Se puede concluir que este acero dual phase cumple con los requerimientos mecánicos, de embutibilidad y de soldabilidad que se exigen en la norma Chilena NCh 214 de fabricación de cilindros de gas, y posee mayor resistencia que el acero A45 GL usado actualmente, por lo que se presenta como un material alternativo para la fabricación de cilindros más livianos.

Starting with a C-Mn-Si AWS 70S-6 steel produced by Huachipato Steel Company (CSH), usually employed to manufacture electrodes for the welding industry, a Dual Phase steel was obtained at the laboratory facilities of USACH by a process of hot rolling and coiling in order to get martensite in a ferritic matrix. The microstructural characterization was complemented by tensile and anisotropy tests. It was determined that the optimum conditions for obtaining the dual phase microstructure from the initial steel are given by an ending rolling temperature near the austenite to ferrite transformation line, followed by quenching to the optimum temperature range of coiling (550 - 600 º C) and furnace cooling. Additionally, three samples were subjected to different heat treatments in order to obtain a dual phase structure in the first specimen; ferrite, bainite and pearlite in the second specimen; and perlite in a ferritic matrix in the third one. Finally, the specimens were MIG welded. The mechanical properties of all the heat affected zones were similar to those of their respective base metals, and hence the dual phase specimen shows the best results. It may be concluded that this dual phase steel meets the mechanical, drawability and weldability requirements established on the Chilean Standard for fabrication of gas cylinders, while having greater resistance than the A45 GL steel presently at use, which turns it into an alternative material for the fabrication of lighter cylinders.